Seahawks Summer Slam Camp Enrolment Form 19th &20th

Dec, 2011
Name: ________________________________________

DOB: ______________________

Address: ________________________________________________________________________
Phone (H): ___________________________

Emergency Phone: ________________________

School: ______________________________

Email: ___________________________________

Parents Name for Contact: ____________________________________

Please note Medical Conditions: ______________________________________________________
What to Bring:

..

Correct Size Basketball

Drink bottle plenty of water & other fluids
Towel.
Lunch and snacks

For further information please contact Frank Goldfinch on 0432 392 338 or Deb Black on 0412 751 037 or email
admin@seahawksgc.com.au
To confirm booking, return form with payment cheque payable to; Seahawks GC Inc by 8th Dec 2011 to:
Seahawks GC Basketball Association, PO Box 1144, Runaway Bay 4216 QLD.
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I hereby authorise the staff of the Seahawks Summer Slam Camp to act for me according to their best judgement in any
emergency requiring medical attention and hereby waive and release the Seahawks GC Basketball Association from any
and all liability for any injury or illness incurred whilst at the camp. I have no knowledge of any physical impairment or
condition held by the above named participant that would be affected by participation in the High Hoops Camp
Programme as outlined on the enrolment form. I also understand that the Seahawks GC Basketball Association retains the
right to use for publicity and advertising purposes, including website photographs of players
taken at the Camp.

Parent / Guardian _________________________________________________________________________

Print Full Name :___________________________________
Date_____________________________

Sign__________________________________

The SEAHAWKS Summer Slam Camp is sanctioned by Basketball Queensland